146 research outputs found
Die SpĂ€tanĂ€mie des Morbus haemolyticus fetalis et neonatorum : Risikofaktoren und PrĂ€diktoren fĂŒr Verlauf sowie Einfluss auf die Gewichtsentwicklung
Fragestellung: Um sowohl einflussnehmende Faktoren und gleichzeitig eine Vorhersage ermöglichende Faktoren den Verlauf der SpĂ€tanĂ€mie im Verlauf eines Morbus haemolyticus fetalis et neonatorum betreffend zu identifizieren, als auch eventuelle Folgen der SpĂ€tanĂ€mie bezĂŒglich der Gewichtsentwicklung der Kinder aufzuzeigen, wurde am Perinatalzentrum Bonn (Abteilung fĂŒr Neonatologie; Direktor Prof. Dr. Dr. P. Bartmann) eine retrospektive Studie durchgefĂŒhrt.Patienten und Methoden: Das Untersuchungskollektiv stellten dabei 82 Kinder der GeburtenjahrgĂ€nge 1995 - 2001, die wĂ€hrend dieser Zeit aufgrund eines MHFN behandelt wurden. Die Daten der betroffenen Kinder wurden unter Einbeziehung folgender Parameter analysiert: Zahl der intrauterinen, postnatalen und Austauschtransfusionen, HĂ€moglobinwerte vor Transfusion, Art der Antikörper, Zahl der Thrombozyten bei Geburt und fetales HĂ€moglobin (HbF) bei Geburt. Als Indikatoren fĂŒr den Verlauf bzw. die Dauer der SpĂ€tanĂ€mie wurden die Faktoren " Zeit in Tagen bis zur letzten Transfusion" und " Zeit in Tagen bis Retikulozyten> 2%" gewĂ€hlt und mit den vorher genannten Faktoren in Beziehung gesetzt. FĂŒr die Erfassung der Gewichtsentwicklung der Kinder wurde zu vier verschiedenen Zeitpunkten bzw. ZeitrĂ€umen das Gewicht anhand von Perzentilenwerten erfasst und ebenfalls mit den Indikatoren fĂŒr die SpĂ€tanĂ€mie in Beziehung gesetzt. Ergebnisse: Signifikante Ergebnisse lieĂen sich bezĂŒglich eines positiven Zusammenhanges zwischen Dauer der SpĂ€tanĂ€mie und Zahl der intrauterinen, postnatalen und der Summe von intrauterinen und postnatalen Transfusionen erkennen. Mit Abnahme des HbF-Wertes der Kinder bei Geburt nahm die Dauer der SpĂ€tanĂ€mie signifikant zu. Je niedriger der Hb-Wert der Kinder vor den Transfusionen war, desto lĂ€nger war die Dauer der SpĂ€tanĂ€mie bei diesen Kindern, ebenfalls signifikant. BezĂŒglich der ĂŒbrigen Faktoren ergaben sich nur Tendenzen, die jedoch statistisch nicht signifikant waren. Demnach zeigte sich bei Kindern mit steigender Zahl von Austauschtransfusionen eine abnehmende Dauer der SpĂ€tanĂ€mie. Die Patienten mit einer Thrombozytopenie von weniger als 150.000 zeigten einen leicht verlĂ€ngerten Verlauf der SpĂ€tanĂ€mie. In der Untersuchung des Einflusses des pathogenen Antikörpers zeigte sich der lĂ€ngste Verlauf der SpĂ€tanĂ€mie bei Kindern mit Anti-Kell- AK-Nachweis. Bei Analyse der Gewichtsentwicklung der betroffenen Kinder zeigten sich insgesamt weitgehend normale Perzentilenwerte mit einer Tendenz zu gering verzögerter Gewichtszunahme mit Zunahme der Dauer der SpĂ€tanĂ€mie ohne Unterschreiten der Altersnorm
Sequelae of premature birth in young adults
Background and Purpose
Qualitative studies about the abnormalities appreciated on routine magnetic resonance imaging (MRI) sequences in prematurely born adults are lacking. This article aimed at filling this knowledge gap by (1) qualitatively describing routine imaging findings in prematurely born adults, (2) evaluating measures for routine image interpretation and (3) investigating the impact of perinatal variables related to premature birth.
Methods
In this study two board-certified radiologists assessed T1-weighted and FLAIR-weighted images of 100 prematurely born adults born very preterm (VP <32 weeks) and/or at very low birth weight (VLBW <1500âŻg) and 106 controls born at full term (FT) (mean age 26.8âŻÂ±â0.7 years). The number of white matter lesions (WML) was counted according to localization. Lateral ventricle volume (LVV) was evaluated subjectively and by measurements of Evansâ index (EI) and frontal-occipital-horn ratio (FOHR). Freesurfer-based volumetry served as reference standard. Miscellaneous incidental findings were noted as free text.
Results
The LVV was increased in 24.7% of VP/VLBW individuals and significantly larger than in FT controls. This was best identified by measurement of FOHR (AUCâŻ=â0.928). Ventricular enlargement was predicted by low gestational age (odds ratio: 0.71, 95% CI 0.51â0.98) and presence of neonatal intracranial hemorrhage (odds ratio: 0.26, 95% CI 0.07â0.92). The numbers of deep and periventricular WML were increased while subcortical WMLs were not.
Conclusion
Enlargement of the LVV and deep and periventricular WMLs are typical sequelae of premature birth that can be appreciated on routine brain MRI. To increase sensitivity of abnormal LVV detection, measurement of FOHR seems feasible in clinical practice
Multiparametric Characterization of Intracranial Gliomas Using Dynamic [18F]FET-PET and Magnetic Resonance Spectroscopy.
Both static and dynamic O-(2-[18F]fluoroethyl)-l-tyrosine-(FET)-PET and 1H magnetic resonance spectroscopy (MRS) are useful tools for grading and prognostication in gliomas. However, little is known about the potential of multimodal imaging comprising both procedures. We therefore acquired NAA/Cr and Cho/Cr ratios in multi-voxel MRS as well as FET-PET parameters in 67 glioma patients and determined multiparametric parameter combinations. Using receiver operating characteristics, differentiation between low-grade and high-grade glioma was possible by static FET-PET (area under the curve (AUC) 0.86, p = 0.001), time-to-peak (TTP; AUC 0.79, p = 0.049), and using the Cho/Cr ratio (AUC 0.72, p = 0.039), while the multimodal analysis led to improved discrimination with an AUC of 0.97 (p = 0.001). In order to distinguish glioblastoma from non-glioblastoma, MRS (NAA/Cr ratio, AUC 0.66, p = 0.031), and dynamic FET-PET (AUC 0.88, p = 0.001) were superior to static FET imaging. The multimodal analysis increased the accuracy with an AUC of 0.97 (p < 0.001). In the survival analysis, PET parameters, but not spectroscopy, were significantly correlated with overall survival (OS, static PET p = 0.014, TTP p = 0.012), still, the multiparametric analysis, including MRS, was also useful for the prediction of OS (p = 0.002). In conclusion, FET-PET and MRS provide complementary information to better characterize gliomas before therapy, which is particularly interesting with respect to the increasing use of hybrid PET/MRI for brain tumors
Prevalence, Enabling Factors, and Clinical Outcome
Background: Striatocapsular infarcts (SCIs) are defined as large subcortical
infarcts involving the territory of more than one lenticulostriate artery. SCI
without concomitant ischemia in the more distal middle cerebral artery (MCA)
territory [isolated SCI (iSCI)] has been described as a rare infarct pattern.
The purpose of this study was to assess the prevalence of iSCI in patients
treated with endovascular thrombectomy (ET), to evaluate baseline and
procedural parameters associated with this condition, and to describe the
clinical course of iSCI patients. Methods: A retrospective analysis of 206
consecutive patients with an isolated MCA occlusion involving the
lenticulostriate arteries and treated with ET was performed. Baseline patient
and procedural characteristics and ischemic involvement of the striatocapsular
and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were
analyzed using multivariate logistic regression models. Prevalence of iSCI was
assessed, and clinical course was determined with the rates of substantial
neurological improvement and good functional short- and mid-term outcome
(discharge/day 90 Modified Rankin Scale â€2). Results: iSCI was detected in 53
patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful
reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds
ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069â71.308] and good
collaterals (aOR 2.100, 95% CI 1.119â3.944) were associated with iSCI. In
successfully reperfused patients, TICI 3 was found to be an additional factor
associated with iSCI (aOR 5.282, 1.759â15.859). Patients with iSCI had higher
rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and
higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p
< 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in
general, had a more favorable outcome, considerable heterogeneity in outcome
was observed. Conclusion: High rates of successful reperfusion (TICI 2b/3) and
in particular, complete reperfusion (TICI 3) are associated with iSCIs. The
high prevalence of iSCI in successfully reperfused patients with good
collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once
considered a rare pattern of cerebral ischemia, is likely to become more
prevalent with increases in endovascular stroke therapy. This may have
implications for patient rehabilitation and pathophysiological analyses of
ischemic damage confined to subcortical regions of the MCA territory
The carotid plaque imaging in acute stroke (CAPIAS) study:
Background: In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design: 300 patients (age > 49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques. Discussion: CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies
Endovascular thrombectomy for basilar artery occlusion stroke: Analysis of the German Stroke RegistryâEndovascular Treatment
Background and purpose
Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice.
Methods
Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (â„8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge â€1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0â2).
Results
Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ±â13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76â5.23) and successful reperfusion (OR 4.92, 95% CI 1.15â21.11), while the effect of time between symptom onset and reperfusion seemed to be small.
Conclusions
Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact
Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal middle Cerebral Artery Occulusion: Prevalence, Enabling Factors, and Clinical Outcomes
Background: Striatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients. Methods: A retrospective analysis of 206 consecutive patients with an isolated MCA occlusion involving the lenticulostriate arteries and treated with ET was performed. Baseline patient and procedural characteristics and ischemic involvement of the striatocapsular and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were analyzed using multivariate logistic regression models. Prevalence of iSCI was assessed, and clinical course was determined with the rates of substantial neurological improvement and good functional short-and mid-term outcome (discharge/day 90 Modified Rankin Scale <= 2). Results: iSCI was detected in 53 patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069-71.308] and good collaterals (aOR 2.100, 95% CI 1.119-3.944) were associated with iSCI. In successfully reperfused patients, TICI 3 was found to be an additional factor associated with iSCI (aOR 5.282, 1.759-15.859). Patients with iSCI had higher rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and higher rates of good functional short-and mid-term outcome (58.3 vs. 23.7%, p < 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in general, had a more favorable outcome, considerable heterogeneity in outcome was observed. Conclusion: High rates of successful reperfusion (TICl 2b/3) and in particular, complete reperfusion (TICl 3) are associated with iSCls. The high prevalence iSCl in successfully reperfused patients with good collaterals corroborates previous concepts of iSCl partho-genesis. iSCl, once considered a rare pattern of cerebral ischemia, is likely to become more prevalent with increase in endovascular stroke therapy. This may have implications for patient rehabilitation and pathophysiological analysis of ischemic damage confind to subcortical regions of the MCA territory
Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy.
Post hoc analyses of randomized controlled clinical trials evaluating mechanical thrombectomy have suggested that admission-to-groin-puncture (ATG) delays are associated with reduced reperfusion rates. Purpose of this analysis was to validate this association in a real-world cohort and to find associated factors and confounders for prolonged ATG intervals.
Patients included into the BEYOND-SWIFT cohort (Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the Solitaire FR With the Intention for Thrombectomy; https://www.clinicaltrials.gov; Unique identifier: NCT03496064) were analyzed (n=2386). Association between baseline characteristics and ATG was evaluated using mixed linear regression analysis. The effect of increasing symptom-onset-to-admission and ATG intervals on successful reperfusion (defined as Thrombolysis in Cerebral Infarction [TICI] 2b-3) was evaluated using logistic regression analysis adjusting for potential confounders.
Median ATG was 73 minutes. Prolonged ATG intervals were associated with the use of magnetic resonance imaging (+19.1 [95% CI, +9.1 to +29.1] minutes), general anesthesia (+12.1 [95% CI, +3.7 to +20.4] minutes), and borderline indication criteria, such as lower National Institutes of Health Stroke Scale, late presentations, or not meeting top-tier early time window eligibility criteria (+13.8 [95% CI, +6.1 to +21.6] minutes). There was a 13% relative odds reduction for TICI 2b-3 (adjusted odds ratio [aOR], 0.87 [95% CI, 0.79-0.96]) and TICI 2c/3 (aOR, 0.87 [95% CI, 0.79-0.95]) per hour ATG delay, while the reduction of TICI 2b-3 per hour increase symptom-onset-to-admission was minor (aOR, 0.97 [95% CI, 0.94-0.99]) and inconsistent regarding TICI 2c/3 (aOR, 0.99 [95% CI, 0.97-1.02]). After adjusting for identified factors associated with prolonged ATG intervals, the association of ATG delay and lower rates of TICI 2b-3 remained tangible (aOR, 0.87 [95% CI, 0.76-0.99]).
There is a great potential to reduce ATG, and potential targets for improvement can be deduced from observational data. The association between in-hospital delay and reduced reperfusion rates is evident in real-world clinical data, underscoring the need to optimize in-hospital workflows. Given the only minor association between symptom-onset-to-admission intervals and reperfusion rates, the causal relationship of this association warrants further research. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064
ISLES 2022: A multi-center magnetic resonance imaging stroke lesion segmentation dataset
Magnetic resonance imaging (MRI) is an important imaging modality in stroke. Computer based automated medical image processing is increasingly finding its way into clinical routine. The Ischemic Stroke Lesion Segmentation (ISLES) challenge is a continuous effort to develop and identify benchmark methods for acute and sub-acute ischemic stroke lesion segmentation. Here we introduce an expert-annotated, multicenter MRI dataset for segmentation of acute to subacute stroke lesions (https://doi.org/10.5281/zenodo.7153326). This dataset comprises 400 multi-vendor MRI cases with high variability in stroke lesion size, quantity and location. It is split into a training dataset of nâ=â250 and a test dataset of nâ=â150. All training data is publicly available. The test dataset will be used for model validation only and will not be released to the public. This dataset serves as the foundation of the ISLES 2022 challenge (https://www.isles-challenge.org/) with the goal of finding algorithmic methods to enable the development and benchmarking of automatic, robust and accurate segmentation methods for ischemic stroke
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